Hinged endotracheal tube holder having both a safety clamp and a securing clamp

ABSTRACT

A holder for retaining an endotracheal tube in a patient&#39;s mouth has upper and lower portions, each including a semi-cylindrical member with wings extending radially on opposite sides. The upper and lower portions are joined by a flexible hinge between a first wing of the upper portion and an opposed first wing of the lower portion. When the hinge is closed, a region of each upper wing is adjacent to a region of a corresponding opposed lower wing, and the semi-cylindrical members form a sleeve defining a lumen sized to receive the endotracheal tube. A safety clamp limits the extent to which the upper and lower portions can pivot apart about the hinge to a predetermined maximum angle, whereby the position of the endotracheal tube can be adjusted axially, but radial displacement of the tube from the holder is restricted. A securing clamp relatively more spaced from the hinge moves between a first position, in which the upper and lower portions are allowed to pivot to the extent allowed by the safety clamp, to allow for axial adjustment of the endotracheal tube while limiting radial movement, and a second position in which the sleeve engages the tube to also limit axial movement of the tube relative to the holder. In use, the endotracheal tube is inserted through a patient&#39;s mouth into the tracheal lumen, the safety clamp of the tube holder is closed, the sleeve of the tube holder is slid over the endotracheal tube, and its position adjusted axially along the length of the tube, and the securing clamp is closed to secure the tube holder firmly in a desired position on the endotracheal tube.

BACKGROUND OF THE INVENTION

The invention relates to holders for endotracheal tubes.

An endotracheal tube is generally inserted in the tracheal lumen of apatient, through the patient's mouth, to deliver air to the patient'slungs when the mouth, throat or trachea of the patient is obstructed.

It is important that the endotracheal tube be securely retained in thepatient's mouth to prevent accidental removal of the tube from thetracheal lumen, which could result in asphyxiation. It is also importantto minimize damage to the mucous membrane of the larynx and tracheacaused by rubbing of the tube against the membrane. The tube must beretained in a manner which will secure it against shifts in thepatient's position, movement of attached ventilating equipment andslippage.

Until relatively recently, endotracheal tubes were typically held inplace by tape. Retaining the tube in this manner was difficult toaccomplish and unreliable, as the tape would not always adhere to thepatient's skin and required a relatively high degree of skill to applyquickly and securely. This method also made it impractical to adjust theorientation of the tube in the tracheal lumen after the initialinsertion.

To remedy this situation, various types of endotracheal tube holdershave been developed. These holders are thought to allow the tube to bemore quickly and easily inserted and positioned, and may include meansfor preventing the patient from biting the tube. However, typicallythese holders do not allow the patient's mouth to be easily accessed bymedical staff, e.g., for the administration of medicaments. Also, manysuch devices require two-handed operation and are not readilyadjustable.

SUMMARY OF THE INVENTION

The present invention features an improved endotracheal tube holderwhich allows a patient's mouth to be readily accessed when theendotracheal tube and holder are in place, and which is easily operatedand adjusted with one hand. The tube holder also provides goodresistance to biting, and it is comfortable to the patient.

According to one aspect of the invention, an endotracheal tube holderfor retaining an endotracheal tube in a patient's mouth comprises upperand lower portions each comprising a semi-cylindrical member and a pairof wings extending radially on opposite sides of the semi-cylindricalmember. The upper portion is joined to the lower portion by a flexiblehinge extending between a first wing of the upper portion and an opposedfirst wing of the lower portion. The wings are arranged and dimensionedso that when the hinge is in a closed position, a region of each wing ofthe upper portion is adjacent to a region of a corresponding opposedwing of the lower portion. The semi-cylindrical members are arranged anddimensioned so that, when the hinge is in a closed position, thesemi-cylindrical members together define a sleeve, the sleeve defining alumen dimensioned to receive the endotracheal tube. A safety clampdisposed in a region of the opposed wings adjacent the hinge is adaptedto limit the extent to which the upper portion and the lower portion canpivot apart about the hinge to a predetermined maximum angle, wherebythe position of the endotracheal tube in the housing can be adjustedaxially and radial displacement the tube from the endotracheal tubeholder is restricted. A securing clamp disposed in a region of opposedwings relatively more spaced from the hinge is adapted to be movedbetween a first position, in which the upper portion and the lowerportion are allowed to pivot to the extent allowed by the safety clamp,to allow for axial adjustment of the endotracheal tube within the lumen,and a second position, in which the sleeve engages the tube in a mannerto limit axial movement thereof of the tube relative to the endotrachealtube holder.

Preferred embodiments of this aspect of the invention may include one ormore of the following additional features. The wings are arranged anddimensioned so that a major portion of each wing is removed from ahorizontal plane defined by the longitudinal axis of thesemi-cylindrical member and a substantially horizontal line takenradially across the semi-cylindrical member. The sleeve includes aplurality of raised structures on its inner surface. The safety clampcomprises a resilient member extending upwardly from the lower portion,through an aperture in the upper portion, the resilient membercomprising a latch member adapted to engage the upper portion and arelease member which, when deflected, disengages the latch member fromthe upper portion. Preferably, the resilient member is dimensioned toallow the upper portion and the lower portion to pivot about the hingeto define an angle of less than about 30°, and more preferably theresilient member is dimensioned to allow the upper portion and the lowerportion to pivot about the hinge to define a maximum angle of from about5° to 10°. The securing clamp comprises a resilient member which extendsupwardly from the lower portion, through an aperture in the upperportion, and which includes a latch member adapted to engage the upperportion and a release member which, when deflected, disengages the latchmember from the upper portion. Preferably, resilient member isdimensioned so that when the latch member engages the upper portion, thelumen defined by the upper and lower semi-cylindrical members has apredetermined diameter which is substantially equal to that of an outersurface of the endotracheal tube. A first portion of each wing, adjacentthe semi-cylindrical portion, extends downwardly (or upwardly) from thehorizontal plane, and a second more remote portion of each wing extendsoutwardly in a plane substantially parallel to the horizontal plane.

In another aspect, the invention features a method of inserting andretaining an endotracheal tube in the tracheal lumen of a patient. Themethod comprises the steps of: inserting the endotracheal tube throughthe patient's mouth into the tracheal lumen; providing an endotrachealtube holder comprising upper and lower portions each comprising asemi-cylindrical member and a pair of wings extending radially onopposite sides of the semi-cylindrical member, the upper portion beingjoined to the lower portion by a flexible hinge extending between afirst wing of the upper portion and an opposed first wing of the lowerportion, the wings being arranged and dimensioned so that when the hingeis in a closed position, a region of each upper wing is adjacent to aregion of a corresponding lower wing, the semi-cylindrical members beingarranged and dimensioned so that, when the hinge is in a closedposition, the semi-cylindrical members together define a sleeve, thesleeve defining a lumen dimensioned to receive the endotracheal tube; asafety clamp, disposed in a region adjacent the hinge and adapted tolimit the extent to which the upper portion and the lower portion canpivot apart about the hinge to a predetermined maximum angle, wherebythe position of the endotracheal tube in the housing can be adjustedaxially and radial displacement of the endotracheal tube from theendotracheal tube holder is restricted; and a securing clamp disposed inthe region spaced further from the hinge and adapted to be moved betweena first position, in which the upper portion and the lower portion areallowed to pivot apart to the extent allowed by the safety clamp, toallow for axial adjustment of the endotracheal tube within the lumenwhile limiting radial movement, and a second position, in which thesleeve engages the tube, thereby also limiting axial movement thereof;closing the safety clamp (without engaging the securing clamp); slidingthe sleeve of the endotracheal tube holder over the endotracheal tube;adjusting the position of the endotracheal tube holder axially along thelength of the endotracheal tube until the endotracheal tube holder is ina desired position; and closing the securing clamp, securing theendotracheal tube holder firmly in position on the endotracheal tube.

Preferred embodiments of this aspect of the invention may include one ormore of the following additional steps. The steps of securing a neck orhead strap to the wings on either side of the housing and fastening thestrap about the neck or head of the patient. The step of closing thesecuring clamp is performed with one hand. The wings are arranged anddimensioned so that a major portion of each wing is removed from ahorizontal plane defined by the longitudinal axis of thesemi-cylindrical member and a substantially horizontal line takenradially across the semi-cylindrical member. The sleeve includes aplurality of raised structures on its inner surface. The safety clampcomprises a resilient member which extends upwardly from the lowerportion, through an aperture in the upper portion, and which includes alatch member adapted to engage the upper portion and a release memberwhich, when deflected, disengages the latch member from the upperportion. The resilient member is dimensioned to allow the upper portionand the lower portion to pivot about the hinge to define an angle ofless than about 30°, preferably, the resilient member is dimensioned toallow the upper portion and the lower portion to pivot about the hingeto define a maximum angle of from about 5° to 10°. The securing clampcomprises a resilient member which extends upwardly from the lowerportion, through an aperture in the upper portion, and which includes alatch member adapted to engage the upper portion and a release memberwhich, when deflected, disengages the latch member from the upperportion. The resilient member is dimensioned so that when the latchmember engages the upper portion the lumen defined by the upper andlower semi-cylindrical members has a predetermined diameter which issubstantially equal to that of an outer surface of the endotrachealtube. A first portion of each wing, adjacent the semi-cylindricalportion, extends downward from the horizontal plane, and a second moreremote portion of each wing extends outwardly in a plane substantiallyparallel to the horizontal plane.

Other features and advantages of the invention will be apparent from thefollowing description of presently preferred embodiments, and from theclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is perspective view of an endotracheal tube holder according toone embodiment of the invention.

FIG. 2 is a front view of the tube holder of FIG. 1.

FIG. 3 is an enlarged cross-sectional view of Detail 3 in FIG. 2.

FIG. 3a is a highly enlarged perspective view of the clamp shown in FIG.3.

FIG. 4 is an enlarged cross-sectional view of Detail 4 in FIG. 2.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to FIGS. 1 and 2, a preferred endotracheal tube holder 10 ofthe invention includes an integral housing 12 having a "clamshell" typestructure, i.e., housing 12 comprises two halves, upper half 20 andlower half 21, which are joined by a flexible hinge 22. Each halfcomprises a semi-cylindrical portion 122a, 122b, and a pair of wings124a, 124b, and 126a, 126b.

When hinge 22 is in a closed position, as shown in FIG. 1,semi-cylindrical portions 122a, 122b form an annular sleeve 14. Sleeve14 defines a lumen 15, dimensioned to receive an endotracheal tube (notshown). Sleeve 14 is preferably formed of a rigid, resilient material,e.g., polypropylene, which has sufficient rigidity to act as a biteguard for the endotracheal tube, preventing the patient from damaging orclosing the tube by biting down on it, and sufficient resiliency toprovide cushioning for patient comfort. Preferably, sleeve 14 has aplurality of longitudinal ribs 18 on its inner surface 11, to provide amore positive grip of the sleeve about the endotracheal tube extendingtherethrough. A flange 123, having portions 123a, 123b, extends radiallyfrom the outer surface of the sleeve in a manner to aid in longitudinalpositioning of the sleeve by engaging gently against a patient's upperand lower front teeth, as described in more detail below.

Each pair of adjacent wings, i.e., pairs 124a, 124b and pairs 126a,126b, forms a wing structure 16a, 16b when hinge 22 is in a closedposition, as shown in FIGS. 1 and 2. The two wing structures curveupwardly, out of a plane defined by the axis of the tube and sleeve 14and a horizontal line A across the patient's mouth, to allow easy accessto the patient's mouth on either side of the housing in a manner tofacilitate more thorough and efficient mouth care. Two neck/head strapholders 19 are mounted on the housing, one on each wing, to receive astrap (not shown) which is fastened behind the patient's neck or head.

The diameter of lumen 15 defined by sleeve 14 is determined by thespacing between the semi-cylindrical members. To adjust this spacing,and to hold the upper and lower halves relatively close together, sothat the holder can be manipulated with one hand, the housing isprovided with a pair of clamps. In the preferred embodiment shown, thehousing includes a securing clamp 30 on wing 16b and a safety clamp 28on wing 16a.

Safety clamp 28, which is closest to hinge 22, is provided to act as astop, limiting the amount of separation between the two halves,preferably to an extent so that, when the hinge is open to the fullestextent allowed by the safety clamp, a lumen is still defined by thesemi-cylindrical portions at least to an extent to prevent radialdisplacement of the tube from the lumen. However, the safety clampallows the diameter of the lumen to be increased sufficiently to allowaxial adjustment of the endotracheal tube, also without allowing the twohalves to become so separated that it is difficult to close them withone hand.

Referring to FIG. 4, safety clamp 28, shown in detail, comprises aresilient member 40 which extends upwardly from wing 124b of the lowerhalf 21 of the housing, through aperture 45 in opposed wing 124a.Resilient member 40 includes a latch member 42 and a release member 44.Wing 124a defines a shoulder 43, positioned for engagement by latchmember 42. Resilient member 40 is dimensioned so that, when latch member42 and shoulder 43 are engaged, as shown in FIG. 4, the two halves ofthe housing can be separated (pivoted about hinge 22) to define amaximum angle B therebetween. Preferably, angle B is less than about30°, more preferably angle B is about 5° to 10°. If it is desired toopen the two halves beyond the extent allowed by the safety latch, latchmember 42 may be released from shoulder 43 by depressing release member44.

Securing clamp 30, when engaged, clamps the housing around the tube,thereby securely holding the tube against both axial and radialdisplacement, and, when disengaged, allows the housing to open to theextent allowed by safety clamp 28.

Referring to FIGS. 3 and 3a, securing clamp 30, shown in detail,comprises resilient member 32, which extends upwardly from wing 126b oflower half 21, through aperture 33 in wing 126a. Resilient member 32includes latch member 34 and release member 36. Securing clamp 30functions in the same manner as does safety clamp 28, i.e., the latchmember engages the upper wing until it is released therefrom bydepressing the release member. (Apertures in the wings 124b, 126b (FIGS.3a and 4, respectively) facilitate the manufacturing process.)

In use, an endotracheal tube is first inserted through the patient'smouth into the tracheal lumen. Then, with the safety clamp closed andthe securing clamp open, the sleeve of the holder is slid over theendotracheal tube and the position of the holder is adjusted axiallyalong the tube until the holder is in a desired position, preferablywith the flange portions engaged gently against the patient's teeth. Aneck/head strap, attached to the wings on either side of the housing, isthen typically fastened about the neck or head of the patient. When adesired position is achieved, the securing clamp is then closed,typically with one hand, securing the tube firmly in position within theholder. If further adjustment of the holder later becomes necessary,this can easily be accomplished by unfastening the securing clamp,sliding the tube axially within the lumen of the holder, and refasteningthe securing clamp.

Other embodiments are within the claims. For example, the ribs 18 onsleeve 14 may, in the alternative, be axial or spiral. Where desired forincreased security against accidental or inadvertent release, e.g. dueto movement or actions by a patient, a second securing clamp may beprovided, preferably at right angle to the first securing clamp, thus torequire use of two hands for release of the device.

What is claimed is:
 1. An endotracheal tube holder for retaining anendotracheal tube in a patient's mouth comprising:an upper portion and alower portion,said upper portion and said lower portion each comprisinga semi-cylindrical member and a pair of wings extending radially onopposite sides of said semi-cylindrical member, said upper portion beingJoined to said lower portion by a flexible hinge extending between afirst said wing of said upper portion and an opposed first said wing ofsaid lower portion, said wings being arranged and dimensioned so thatwhen said hinge is in a closed position, a region of each wing of saidupper portion is adjacent to a region of a corresponding opposed wing ofsaid lower portion, and said semi-cylindrical members being arranged anddimensioned so that, when said hinge is in a closed position, thesemi-cylindrical members together define a lumen dimensioned to receivethe endotracheal tube; a safety clamp, disposed in a region of theopposed wings adjacent said hinge and including means for limiting, byinterference engagement, the extent to which said upper portion and saidlower portion can pivot apart about said hinge to a predeterminedmaximum angle, said predetermined angle being sufficiently large toallow the position of the endotracheal tube in the housing to beadjusted axially, and sufficiently small so that said tube cannot beradially displaced from the endotracheal tube holder when the safetyclamp is engaged; and a securing clamp disposed in a region of theopposed wings relatively more spaced from said hinge and resilientlymovable between a first position, in which said upper portion and saidlower portion are allowed to pivot to the extent allowed by said safetyclamp, to allow for axial adjustment of the endotracheal tube withinsaid lumen, and a second position, in which the semi-cylindrical membersengage the tube in a manner to limit axial movement of the tube relativeto said endotracheal tube holder.
 2. An endotracheal tube holder ofclaim 1 wherein said wings are arranged and dimensioned so that a majorportion of each wing is removed from a horizontal plane defined by thelongitudinal axis of the semi-cylindrical member and a substantiallyhorizontal line taken radially across the semi-cylindrical member.
 3. Anendotracheal tube holder of claim 2 wherein a first portion of each saidwing, adjacent said semi-cylindrical portion, extends downwardly fromsaid horizontal plane, and a second, more remote portion of each saidwing extends outwardly in a plane substantially parallel to saidhorizontal plane.
 4. An endotracheal tube holder of claim 1 wherein saidsemi-cylindrical members include a plurality of raised structures ontheir inner surfaces.
 5. An endotracheal tube holder of claim 1 whereinsaid safety clamp comprises a resilient member extending upwardly fromsaid lower portion, through an aperture in said upper portion, saidresilient member comprising a latch member adapted to engage said upperportion, and a release member which, when deflected, disengages saidlatch member from said upper portion.
 6. An endotracheal tube holder ofclaim 5 wherein said resilient member is dimensioned to allow said upperportion and said lower portion to pivot about said hinge to define anangle of less than about 30°.
 7. An endotracheal tube holder of claim 6wherein said resilient member is dimensioned to allow said upper portionand said lower portion to pivot about said hinge to define a maximumangle of from about 5° to 10°.
 8. An endotracheal tube holder of claim 1wherein said securing clamp comprises a resilient member which extendsupwardly from said lower portion, through an aperture in said upperportion, and which includes a latch member adapted to engage said upperportion and a release member which, when deflected, disengages saidlatch member from said upper portion.
 9. An endotracheal tube holder ofclaim 8 wherein said resilient member is dimensioned so that when saidlatch member engages said upper portion, the lumen defined by the upperand lower semi-cylindrical members has a predetermined diameter which issubstantially equal to that of an outer surface of the endotrachealtube.
 10. A method of inserting and retaining an endotracheal tube inthe tracheal lumen of a patient comprising the steps of:inserting theendotracheal tube through the patient's mouth into the tracheal lumen;providing an endotracheal tube holder comprising: an upper portion and alower portion, said upper portion and said lower portion each comprisinga semi-cylindrical member and a pair of wings extending radially onopposite sides of said semi-cylindrical member, said upper portion beingjoined to said lower portion by a flexible hinge extending between afirst said wing of said upper portion and an opposed first said wing ofsaid lower portion, said wings being arranged and dimensioned so thatwhen said hinge is in a closed position, a region of each upper wing isadjacent to a region of a corresponding lower wing, saidsemi-cylindrical members being arranged and dimensioned so that, whensaid hinge is in a closed position, the semi-cylindrical memberstogether define a lumen dimensioned to receive the endotracheal tube; asafety clamp disposed in a region adjacent said hinge and adapted, byinterference engagement, to limit the extent to which said upper portionand said lower portion can pivot apart about said hinge to apredetermined maximum angle; and a securing clamp disposed in a regionspaced further from said hinge; dimensioning and positioning the safetyclamp so that the predetermined maximum angle is sufficiently large toallow the position of the endotracheal tube in the housing to beadjusted axially, and sufficiently small so that the tube cannot beradially displaced from the endotracheal tube holder when the safetyclamp is engaged; dimensioning and positioning the securing clamp sothat it can be moved between a first position, in which the securingclamp is disengaged and the upper portion and the lower portion areallowed to pivot apart to the extent allowed by the safety clamp and asecond position, in which the sleeve engages the tube, to limit axialmovement of the tube relative to the lumen; sliding the endotrachealtube holder over the endotracheal tube so that the tube is received inthe lumen; closing the safety clamp; with the securing clamp disengaged,adjusting the position of the endotracheal tube holder axially along thelength of the endotracheal tube until the endotracheal tube holder is ina desired position; and closing the securing clamp, thereby securing theendotracheal tube holder firmly in position on the endotracheal tube.11. A method of claim 10, further comprising the steps of securing aneck/head strap to the wings on either side of the housing and fasteningthe strap about the neck or head of the patient.
 12. A method of claim10, wherein said step of closing the securing clamp is performed withone hand.
 13. A method of claim 10 further comprising the step ofdimensioning and arranging the wings so that a major portion of eachwing is removed from a horizontal plane defined by the longitudinal axisof the semi-cylindrical member and a substantially horizontal line takenradially across the semi-cylindrical member allowing the further stepsof, after the securing clamp is engaged, accessing the patient's mouthon either side of the housing and performing mouth care.
 14. A method ofclaim 10 wherein the safety clamp comprises a resilient safety clampmember which extends upwardly from the lower portion, and a safety clamplatch member extending from the resilient safety clamp member andpositioned for interference engagement with a region of the upperportion, and said step of closing the safety clamp includes insertingthe resilient safety clamp member through an aperture in the upperportion in manner to cause inference engagement of the safety clamplatch member with a region of the upper portion adjacent the aperture.15. A method of claim 14 further comprising the step of dimensioning theresilient safety clamp member to allow the upper potion and the lowerportion to pivot about the hinge to define an angle of less than about30° when the safety clamp is closed and in interference engagement. 16.A method of claim 15 further comprising the step of, after closing thesafety clamp, pivoting the upper portion and the lower portion about thehinge to define a maximum angle of from about 5° to 10°.
 17. A method ofclaim 14 wherein the safety clamp further comprises a safety clamprelease member, adjacent the safety clamp latch member, shaped andpositioned to when deflected, disengage the safety clamp latch memberfrom the upper portion, and said method further includes, after the stepof closing the securing clamp, the sequential steps of releasing thesecuring clamp, removing the tube holder form the endotracheal tube, andreleasing the safety clamp by deflecting the release member to disengagethe safety clamp latch member from the upper portion.
 18. A method ofclaim 10 wherein the securing clamp comprises a resilient securingmember which extends upwardly from the lower portion, and a securinglatch member extending from the resilient securing member, and said stepof closing the securing clamp includes inserting the resilient securingmember through an aperture in the upper portion to place the securinglatch member in interference engagement with a region of the upperportion adjacent the aperture.
 19. A method of claim 18 furthercomprising the step of dimensioning the resilient securing member sothat when the securing latch member engages the region of the upperportion, the lumen defined by the upper and lower semi-cylindricalmembers has a predetermined diameter which is substantially equal tothat of the outer surface of the endotracheal tubes.
 20. A method ofclaim 18 wherein the securing clamp further comprises a securing clamprelease member, adjacent the securing latch member, shaped andpositioned to, when deflected, disengage the securing latch member fromthe upper portion, and said method further includes the step of, afterthe step of closing the securing clamp, releasing the securing clamp bydeflecting the securing clamp release member to disengage the securinglatch member from the upper portion.
 21. An endotracheal tube holder forretaining an endotracheal tube in a patient's mouth comprising:an upperportion and a lower portion,said upper portion and said lower portioneach comprising a semi-cylindrical member and a pair of wings extendingradially on opposite sides of said semi-cylindrical member, said upperportion being joined to said lower portion by a flexible hinge extendingbetween a first said wing of said upper portion and an opposed firstsaid wing of said lower portion, said wings being arranged anddimensioned so that when said hinge is in a closed position, a region ofeach wing of said upper portion is adjacent to a region of acorresponding opposed wing of said lower portion, and saidsemi-cylindrical members being arranged and dimensioned so that, whensaid hinge is in a closed position, the semi-cylindrical memberstogether define a lumen dimensioned to receive the endotracheal tube; asafety clamp, disposed in a region of the opposed wings and includingmeans for limiting, by interference engagement, the extent to which saidupper portion and said lower portion can pivot apart about said hinge toa predetermined maximum angle, said predetermined maximum angle beingsufficiently large to allow the position of the endotracheal tube in thehousing to be adjusted axially, and sufficiently small so that said tubecannot be radially displaced from the endotracheal tube holder when saidsafety clamp is engaged; and a securing clamp disposed in a region ofthe opposed wings and adapted to be moved between a first position, inwhich said upper portion and said lower portion are allowed to pivot tothe extent allowed by said safety clamp, to allow for axial adjustmentof the endotracheal tube within said lumen, and a second position, inwhich the semi-cylindrical members engage the tube in a manner to limitaxial movement of the tube relative to said endotracheal tube holder.22. An endotracheal tube holder for retaining an endotracheal tube in apatient's mouth comprising:an upper portion and a lower portion,saidupper portion and said lower portion each comprising a semi-cylindricalmember and a pair of wings extending radially on opposite sides of saidsemi-cylindrical member, said upper portion being joined to said lowerportion by a flexible hinge extending between a first said wing of saidupper portion and an opposed first said wing of said lower portion, saidwings being arranged and dimensioned so that when said hinge is in aclosed position, a region of each wing of said upper portion is adjacentto a region of a corresponding opposed wing of said lower portion, andsaid semi-cylindrical members being arranged and dimensioned so that,when said hinge is in a closed position, the semi-cylindrical memberstogether define a lumen dimensioned to receive the endotracheal tube; asafety clamp, disposed in a region of the opposed wings adjacent saidhinge and including means for limiting, by interference engagement, theextent to which said upper portion and said lower portion can pivotapart about said hinge to a predetermined maximum angle of from about 5°to 10° when the safety clamp is engaged; and a securing clamp disposedin a region of the opposed wings relatively more spaced from said hingeand resiliently movable between a first position, in which said upperportion and said lower portion are allowed to pivot to the extentallowed by said safety clamp, to allow for axial adjustment of theendotracheal tube within said lumen, and a second position, in which thesemi-cylindrical members engage the tube in a manner to limit axialmovement of the tube relative to said endotracheal tube holder.
 23. Anendotracheal tube holder of claim 22, 21 or 20, wherein said wings arearranged and dimensioned so that a major portion of each wing is removedfrom a horizontal plane defined by the longitudinal axis of thesemi-cylindrical member and a substantially horizontal line takenradially across the semi-cylindrical member.
 24. An endotracheal tubeholder of claim 23 wherein a first portion of each said wing, adjacentsaid semi-cylindrical portion, extends downwardly from said horizontalplane, and a second, more remote portion of each said wing extendsoutwardly in a plane substantially parallel to said horizontal plane.25. An endotracheal tube holder for retaining an endotracheal tube in apatient's mouth comprising:an upper portion and a lower portion,saidupper portion and said lower portion each comprising a semi-cylindricalmember and a pair of wings extending radially on opposite sides of saidsemi-cylindrical member, said upper portion being joined to said lowerportion by a flexible hinge extending between a first said wing of saidupper portion and an opposed first said wing of said lower portion, saidupper and lower portions being movable about said hinge between a first,closed position and a second open position in which said upper and lowermembers define an angle of greater than about 30°; said wings beingarranged and dimensioned so that when said hinge is in a closedposition, a region of each wing of said upper portion is adjacent to aregion of a corresponding opposed wing of said lower portion, and saidsemi-cylindrical members being arranged and dimensioned so that, whensaid hinge is in a closed position, the semi-cylindrical memberstogether define a lumen dimensioned to receive the endotracheal tube; asafety clamp, disposed in a region of the opposed wings adjacent saidhinge and movable between a first position in which said safety clamp isdisengaged, and a second position in which said safety clamp is engaged,said safety clamp including means for limiting, by interferenceengagement, the extent to which said upper portion and said lowerportion can pivot apart about said hinge to a predetermined maximumangle of less than about 30° when the safety clamp is engaged; and asecuring clamp disposed in a region of the opposed wings relatively morespaced from said hinge and resiliently movable between a first position,in which said upper portion and said lower portion are allowed to pivotto the extent allowed by said safety clamp, to allow for axialadjustment of the endotracheal tube within said lumen, and a secondposition, in which the semi-cylindrical members engage the tube in amanner to limit axial movement of the tube relative to said endotrachealtube holder.
 26. An endotracheal tube holder for retaining anendotracheal tube in a patient's mouth comprising:an upper portion and alower portion,said upper portion and said lower portion each comprisinga semi-cylindrical member and a pair of wings extending radially onopposite sides of said semi-cylindrical member, said upper portion beingjoined to said lower portion by a flexible hinge extending between afirst said wing of said upper portion and an opposed first said wing ofsaid lower portion, said wings being arranged and dimensioned so thatwhen said hinge is in a closed position, a region of each wing of saidupper portion is adjacent to a region of a corresponding opposed wing ofsaid lower portion, and said semi-cylindrical members being arranged anddimensioned so that, when said hinge is in a closed position, thesemi-cylindrical members together define a lumen dimensioned to receivethe endotracheal tube; a safety clamp, disposed in a region of theopposed wings adjacent said hinge and comprising a resilient memberextending upwardly from said one of said upper and lower portions,through an aperture in the opposite lower or upper portion, saidresilient member comprising a latch member adapted to engage saidopposite portion, and a release member which, when deflected, disengagessaid latch member from said opposite portion; and a securing clampdisposed in a region of the opposed wings relatively more spaced fromsaid hinge and resiliently movable between a first position, in whichsaid upper portion and said lower portion are allowed to pivot to theextent allowed by said safety clamp, to allow for axial adjustment ofthe endotracheal tube within said lumen, and a second position, in whichthe semi-cylindrical members engage the tube in a manner to limit axialmovement of the tube relative to said endotracheal tube holder.